Identification Of Action Areas To Make Routine Glaucoma And Cataract Surgery More Carbon Neutral

To identify opportunities to incorporate sustainable practices for routine glaucoma and cataract surgeries in a tertiary referral centre within the UK National Health Service and identify readily actionable strategies to implement them. The secondary aim is to generate awareness, build consensus and encourage dialogue amongst stakeholders (surgeons, nursing and administrative staff).

The operating theatres at Moorfields Eye Hospital, London.

A routine cataract and trabeculectomy custom surgical tray was photographed and catalogued. Physical data was obtained by separating paper, plastic and metals and then photographed. Disposal streams of all items including single-use metal instruments (eg capsulorhexis forceps, phaco-chopper and phacoemulsification tip etc) were traced. Items were catalogued by manufacturer and place of manufacturing where possible. The study included data from medical equipment used. The timing of air ventilation operation within the theatre was noted. A discussion with the trust theatre manager followed to identify immediate, short and long-term steps to lower the impact of glaucoma and cataract surgeries upon the environment.

Single use metal instruments were disposed in regular sharps bins, domestic waste went to a landfill, clinical waste was incinerated and three plastic sponge holders were found in each tray. Three primary action points were identified: Firstly, plastic sponge holders can be replaced with autoclavable metal ones. Secondly, air ventilation in theatres needs to be functional only 30 min before surgery, significantly reducing the carbon footprint from running theatres when not in use. Thirdly, waste segregation and recycling were not undertaken. Discussions with theatre managers took place to inquire about getting access to more waste streams eg. option of mixed recycling bags and single use instrument recycling boxes offered by some companies.

The increasing numbers of cataract surgery worldwide, combined with the increased frequency of minimally invasive glaucoma surgeries provides a unique opportunity for glaucoma surgeons to reduce their environmental impact. A more sustainable surgical approach will require identication of readily actionable items at each hospital as well as trust sustainability leads within institutions. Partnership with pharmaceutical and medical equipment industry will ultimately be essential in achieving carbon neutrality.